Chronic pain often co-occurs with tobacco dependence. Nicotine’s acute analgesic effects may increase the reward value of cigarettes and patients report smoking to cope with pain. These factors may hinder smoking cessation outcomes for individuals experiencing chronic pain; however, research on smoking cessation outcomes in this population has been limited. This study examined whether self-reported chronic pain diagnosis was associated with smoking cessation outcome among primary care patients seeking treatment to quit smoking.
A secondary analysis was conducted using data from 48,573 patients who enrolled in a primary care-based smoking cessation program in Ontario between 2016 and 2019. We compared baseline and treatment characteristics of patients with and without a self-reported lifetime chronic pain diagnosis and used logistic generalized estimating equations to assess the association between chronic pain diagnosis at enrolment and 30-day point prevalence smoking abstinence at 6 months.
Approximately one-third of the sample (34.6%, n=16,793) reported having a chronic pain diagnosis, of whom 72.2% (n=11,369) were currently using medication for this condition. Those who reported a chronic pain diagnosis had a lower probability of past 30-day smoking abstinence at 6-month follow-up: unadjusted, 20.1% (19.4%-20.8%) vs. 24.7% (24.1%-25.3%), OR=0.77, 95% CI=0.73-0.82, p<0.001; adjusted, 20.7% (19.8%-21.6%) vs. 22.4% (21.6%-23.2%), AOR=0.90, 95% CI=0.85-0.96, p=0.001.
Self-reported lifetime chronic pain diagnosis was associated with a modest decrease in response to treatment with nicotine replacement therapy combined with behavioural support. Further research is needed to clarify how and for whom chronic pain impacts cessation outcomes.
The findings of this study suggest that primary care patients with a self-reported chronic pain diagnosis experience significantly worse smoking cessation outcomes following treatment with nicotine replacement therapy, and that opioid use is also independently associated with poorer quit outcome. These associations were still significant after controlling for important potential confounding factors such as cannabis and alcohol use, heaviness of smoking, psychiatric comorbidity, and confidence in quitting. Further work is needed to establish whether addressing smoking cessation and pain management together may improve smoking cessation outcomes and reduce the burden of smoking-related health issues in this population.